The history of the development of the Republican alternative to Obamacare since the beginning of the health-care debate, in 2009, has been an endless loop of loud promises that a full plan will be announced soon, followed by quiet admissions that it will not. Seventeen days ago, Donald Trump promised a vote to repeal the law “probably some time next week” with a vote for a replacement “very quickly or simultaneously, very shortly thereafter.” At a meeting in Philadelphia yesterday, Trump and his House Republican allies produced no agreement on a plan. If there is a consensus, it is that there will be no replacement plan at all.

Representative Greg Walden, a key leader of the House Republican efforts on health care, tells Julie Rovner, “There’s no single fix. There’s no single plan.” Representative Marsha Blackburn touted bills to limit medical malpractice lawsuits and to allow the sale of state-regulated insurance across state lines. Neither of these proposals would have any significant impact on insurance coverage. If Obamacare is repealed, this would leave the individual-health-insurance market a smoldering crater.

Republicans are portraying the lack of a plan as a philosophical aversion to lengthy legislation. “If you’re waiting for another 2,700-page bill to emerge, you’re going to have to wait until the sun doesn’t come up, because that’s not how we’re going to do it,” says Walden. You may not need 2,700 pages of legislative text. But you can’t blow up the health-care system and replace it with a series of piecemeal measures. Any real plan to provide even crappy coverage — let alone the better, more affordable coverage Trump has repeatedly promised — is going to need to be paid for. Making those trade-offs means figuring out some big-picture strategy for where the money will come from.

The reason health-care reform is done by assembling a big bill with a high page count is that all the stakeholders want to know beforehand whether the final product will be acceptable to them. Hospitals or insurers or doctors or drug makers might be willing to accept provisions that hurt their bottom line if there are other provisions that help them. But they won’t support passing a bill that hurts them on the promise of getting help in a future bill, because they don’t know whether the future bill will pass. Going step by step is a talking point, not a plausible way to actually write laws.

Step-by-step changes could work if they leave the current system in place and alter it incrementally. But if you blow the market up, you need comprehensive changes to rebuild something in its place.

Several Senate Republicans have expressed severe reservations about repealing Obamacare without having a replacement. Now the House is admitting there isn’t going to be a replacement. So now the choice falls to Republicans to either defeat repeal, or allow the system to hurtle toward chaos.

Update: The Washington Post has obtained a recording of House and Senate Republican meeting over how to proceed on Obamacare. The meeting, held privately, suggests that Republicans have even less idea over how to proceed than their public comments suggest. There appears to be no consensus on anything. Can Republicans repeal the law through a budget reconciliation bill, and then try to pass a replacement later? They don’t know. (“The fact is, we cannot repeal Obamacare through reconciliation,” says Rep. Tom McClintock. “We need to understand exactly, what does that reconciliation market look like? And I haven’t heard the answer yet.”) Are they going to keep the law’s expansion of Medicaid? They don’t even agree on attaching a measure to defund Planned Parenthood.

Numerous members expressed fears about the backlash they would face by snatching coverage from 20 million Americans. They have spent eight years promising to implement something better, and the Republican party is still gawking at a whiteboard trying to figure out step one.

The whole argument over capping medical malpractice lawsuits is bogus. Texas capped their lawsuits and it had no impact on the cost of healthcare. When poor people sue for malpractice the lawyers often take it on a contingency. If the lawsuit is capped lawyers aren't going to be as willing to take these cases and poor people won't have the resources to sue.

Capping these lawsuits is just a way to protect the 1% so I'm sure it will be at the top of the Republicans agenda. To hell with everybody else.....

Dumb Republican fucks can't even tie their own shoelaces never mind replace the ACA.

The problem with the ACA is that it is the Republican plan. It was written by conservatives and implemented by a Republican governor. It's 100% run by private corporations who compete for customers in a market that maximizes profits for them. It's about as Republican as you can get......

Any other plan that covers everyone has to lean more to the left. There is nowhere else to go.....

The moment the Republicans repeal the ACA and all the misinformed people who voted for them learn that Obamacare is indeed the ACA, the insurance companies are going to drop all of those with preexisting conditions (which can range from once having a yeast infection to being hospitalized for an appendectomy to anything the insurance companies deem a preexisting condition) and there will be millions losing their insurance and angry at the Republican party. Some Republicans have proposed delaying the repeal so that it won't take effect until 2021, after the next presidential election. However, we all know the insurance companies are not going to play ball with the Republicans. They'll see those bonuses from dropping all of those coverage costs and they'll turn on those who are either currently sick or have preexisting conditions like rabid dogs. Remember what happened in 2006 when all those House and Senate seats flipped? Looks like we're due for a repeat.

The whole argument over capping medical malpractice lawsuits is bogus. Texas capped their lawsuits and it had no impact on the cost of healthcare. When poor people sue for malpractice the lawyers often take it on a contingency. If the lawsuit is capped lawyers aren't going to be as willing to take these cases and poor people won't have the resources to sue.

Capping these lawsuits is just a way to protect the 1% so I'm sure it will be at the top of the Republicans agenda. To hell with everybody else.....

This is typically referred to as tort reform.

I have a conflict here. For one, yes, Americans like to sue all the time, anytime, and often for way more than they deserve.

However, without the ability to hold people accountable and in significant ways, there's no way to reduce the recurrence. If I can take you for $1000 and get a slap on the wrist, I'll probably do it again.

As for the ACA, everyone will, at some point, need to use healthcare. So it makes sense to pay into the system as a requirement. On top of this, you benefit in a few significant ways:

1. Just like buying in bulk, the more people paying into an insurance the pool, the cheaper it gets.2. The cost of stage 1 cancer is less burden on the paying public than stage 5 with no insurance. The incentive to go to the doctor is higher sooner when you're feeling ill.3. Having a healthy population means less disease being spread (cost), more people in the workforce (output), people working longer (in a lifetime, increasing available experience), and improved economic output overall.4. You were already paying for the uninsured in increased costs. This is the part that galls me the most. When you go to the ER without insurance, SOMEONE pays for it. So effectively everyone was paying for this in some form anyway. So paying the up-front costs of having insurance was probably a huge bargain.5. The "Death Panel" conversation was the opposite of reality. Previously you had a lifetime benefits cap. With the ACA there is no lifetime cap. If you have a terminal disease and live longer than expected, your healthcare cannot be cut off. You can continue to receive care as long as you live. I was so pissed at this "Death Panel" shit circulating. Without the law you...will...die...from a terminal disease when your limit is up (unless you're filthy rich).

Repealing this law will cost lives, without any question people will die without timely care, affordable care, or preventative medicine. The message from Republicans is clear: "Once you're out of the womb, good fucking luck."

The whole argument over capping medical malpractice lawsuits is bogus. Texas capped their lawsuits and it had no impact on the cost of healthcare. When poor people sue for malpractice the lawyers often take it on a contingency. If the lawsuit is capped lawyers aren't going to be as willing to take these cases and poor people won't have the resources to sue.

Capping these lawsuits is just a way to protect the 1% so I'm sure it will be at the top of the Republicans agenda. To hell with everybody else.....

This is typically referred to as tort reform.

I have a conflict here. For one, yes, Americans like to sue all the time, anytime, and often for way more than they deserve.

However, without the ability to hold people accountable and in significant ways, there's no way to reduce the recurrence. If I can take you for $1000 and get a slap on the wrist, I'll probably do it again.

As for the ACA, everyone will, at some point, need to use healthcare. So it makes sense to pay into the system as a requirement. On top of this, you benefit in a few significant ways:

1. Just like buying in bulk, the more people paying into an insurance the pool, the cheaper it gets.2. The cost of stage 1 cancer is less burden on the paying public than stage 5 with no insurance. The incentive to go to the doctor is higher sooner when you're feeling ill.3. Having a healthy population means less disease being spread (cost), more people in the workforce (output), people working longer (in a lifetime, increasing available experience), and improved economic output overall.4. You were already paying for the uninsured in increased costs. This is the part that galls me the most. When you go to the ER without insurance, SOMEONE pays for it. So effectively everyone was paying for this in some form anyway. So paying the up-front costs of having insurance was probably a huge bargain.5. The "Death Panel" conversation was the opposite of reality. Previously you had a lifetime benefits cap. With the ACA there is no lifetime cap. If you have a terminal disease and live longer than expected, your healthcare cannot be cut off. You can continue to receive care as long as you live. I was so pissed at this "Death Panel" shit circulating. Without the law you...will...die...from a terminal disease when your limit is up (unless you're filthy rich).

Repealing this law will cost lives, without any question people will die without timely care, affordable care, or preventative medicine. The message from Republicans is clear: "Once you're out of the womb, good fucking luck."

I agree with your first four points. I disagree about the death panels. The Republicans were 100% correct about that. The ACA did indeed lead to government death panels. Paul Ryan is currently the head of this panel and he and his fellow deplorables are sitting under that dome right now deciding which Americans will live and which ones will die. They were right all along. They just didn't tell us that they would be the ones on the panels!

Repealing ObamaCare doesn't just cost lives. It also costs jobs. I have a good paying job that only exists because of ObamaCare. If they were to do a full repeal then my job would vanish. I don't expect to lose my job as the part of the law that my job is based is a tiny little pilot program that nobody has ever heard of and it is expected to remain in place.

Unlike every other form of insurance, Obama-care charges everyone the same amount regardless of need or want. Women use a lot more health care than men do, yet both are charged the same amount.

Until all insurance goes gender blind, then this is discriminatory.

The EU went gender blind because women got butt hurt about having to pay more on certain types of insurance, but then had a hissy fit because other types of insurance went up to match male insurance costs.

Unlike every other form of insurance, Obama-care charges everyone the same amount regardless of need or want. Women use a lot more health care than men do, yet both are charged the same amount.

Until all insurance goes gender blind, then this is discriminatory.

The EU went gender blind because women got butt hurt about having to pay more on certain types of insurance, but then had a hissy fit because other types of insurance went up to match male insurance costs.

Um, isn't charging the same amount regardless of gender part of being gender blind? Or is this sarcasm?

If all the sexes are equal, then equal cost makes it gender-blind. You end up paying part of the costs you need instead of an up-front increase based on having a vagina.

For example, Your doctor visits all cost the same. Your premiums cost the same. Your deductible is the same, etc. And when it comes time to deliver a baby, those associated costs (deducible, etc) are also paid, so in that way, as a woman with extra medical needs, you're covering your part without paying more for everything. Just the parts that are specific.

Unlike every other form of insurance, Obama-care charges everyone the same amount regardless of need or want. Women use a lot more health care than men do, yet both are charged the same amount.

Until all insurance goes gender blind, then this is discriminatory.

The EU went gender blind because women got butt hurt about having to pay more on certain types of insurance, but then had a hissy fit because other types of insurance went up to match male insurance costs.

It's not discriminatory as long as the same criteria is being used to set the premium cost for both genders. Gender was removed from the equation so there can't be gender discrimination.

Every stat you look at shows that women use more health care than men, hence why women paid more.

Every stat shows that women, while having more accidents, they are at lower speed, thus costing less, hence they pay less.

Every stat shows that women live longer, hence they pay less for life insurance.

Obama-care has men subsidizing women's health care, but men don't get subsided by women for the other forms of insurance. It's the feminist version of gender equality.

Heck, the BBC fired a woman doctor because she said that men need to stop going to the doctor so more women can be seen, even though she admitted that women were already the vast majority of GP patients.

But your premium isn't based on how many services you are using. The risk adjustment process isn't taking into account the risk of each individual person. Medical underwriting was eliminated under ObamaCare.

African Americans account for a higher percentage of heart disease and diabetes cases. Should we charge them more?

But your premium isn't based on how many services you are using. The risk adjustment process isn't taking into account the risk of each individual person. Medical underwriting was eliminated under ObamaCare.

African Americans account for a higher percentage of heart disease and diabetes cases. Should we charge them more?

I wish you hadn't asked that question because now we're going to get a racist response from him. The bottom line of all of this is Republicans know once they repeal this law and the very people who believed Obamacare and the ACA were two different things figure out that they were benefiting from the subsidies and everything else, they're going to turn on the Republican party almost instantly. I wouldn't be surprised if the Republicans leave the law in place as is at this point.

Many Republicans are expressing concern over it's repeal especially Republican governors. It was easy to hate Obamacare when they thought we were stuck with it. The actual prospect of repeal is a much more difficult thing. People will die and jobs will be lost.

But your premium isn't based on how many services you are using. The risk adjustment process isn't taking into account the risk of each individual person. Medical underwriting was eliminated under ObamaCare.

African Americans account for a higher percentage of heart disease and diabetes cases. Should we charge them more?

I wish you hadn't asked that question because now we're going to get a racist response from him. ...................

Uhuru, Y'all

So it's racist to say that medical insurance should be underwritten like all other insurance?

What is racist is to say that whites have to subsidize the health insurance of black people. Blacks would have a hissy fit if they had to subsidize white people.

Like with feminists, you claim to want "equality" while demanding special rights/treatment.

I keep forgetting that you can't have any discussion without declaring anyone who disagrees with you as a racist.

ME: I like yellow carsYOU: That's because you are racist

ME: I like cookouts in the summer.YOU: That's the most racist thing anyone could say

Every stat you look at shows that women use more health care than men, hence why women paid more.

Every stat shows that women, while having more accidents, they are at lower speed, thus costing less, hence they pay less.

Every stat shows that women live longer, hence they pay less for life insurance.

Obama-care has men subsidizing women's health care, but men don't get subsided by women for the other forms of insurance. It's the feminist version of gender equality.

Heck, the BBC fired a woman doctor because she said that men need to stop going to the doctor so more women can be seen, even though she admitted that women were already the vast majority of GP patients.

But your premium isn't based on how many services you are using. The risk adjustment process isn't taking into account the risk of each individual person. Medical underwriting was eliminated under ObamaCare.

African Americans account for a higher percentage of heart disease and diabetes cases. Should we charge them more?

Ok...I've read a little regarding Obamacare and I must say this: in order to null underwriting, ALL users are being charged the same amount. Problem is, as raphjd said, there are people who use more health care, so others are charged more in order to compensate.

Now, I don't see a problem with that, society is made upon accepting rights and obligations.

The problem comes when certain groups, in this specific case, women (3rd wave feminists), advocate for an unequal treatment. Here again, have another example: some women are just fine that men are charged more in order to cover their (the females') healthcare, but will jump at the notion of a female being charged more in order to cover a male's healthcare.

raphjd mentioned and extreme case: a female doctor was saying that men, who now have to pay more, should stop coming to the doctor in order so that more females, get more medical attention...when they already use it the most.

Same applies with race. If you are going to subsidize another group's healthcare, they must be willing to do the same for another group or for you, if the situation where you need more healthcare arises.

There are black people, who think white people should be sacrificed for their sake. They have no qualms regarding white people paying more, but if you ask them to pay more healthcare for another race (and when you tell them 'another race' they are thinking 'white people'), they label it as racist and raise their fists.

You can't have one sole group giving out to others. You can't have specific groups receiving special treatments but refusing to give something away in return, or to cooperate when the need arises.